Carcinoma in situ and microinvasive squamous cell carcinoma of the vocal cords.

A retrospective study was undertaken to assess the outcome of 20 patients who underwent microlaryngoscopy and stripping of their vocal cord(s) with and without laser ablation of adjacent tissue for carcinoma in situ and/or microinvasive squamous cell carcinoma of the glottic larynx. Eighteen of 20 (90%) patients are currently free of disease following this course of treatment. The two treatment failures were in patients who had been lost to follow-up. A structured approach is presented to the clinical management of carcinoma in situ and microinvasive squamous cell carcinoma. We propose that the technique of tissue removal, microcup forceps stripping with or without laser ablation, is not the critical determinant of successful outcome, but rather that compulsive follow-up is most important to ultimate treatment success.

Isolated sphenoid sinus disease.

Isolated sphenoid sinus disease is an unusual entity that is encountered infrequently. With advances in antibiotic therapy and imaging techniques, the nature of isolated sphenoid sinus disease has significantly changed. More tumors and less inflammatory disorders are being encountered. We have retrospectively reviewed the medical records of patients who had undergone sublabial transseptal sphenoidotomy for isolated sphenoid sinus disease at Allegheny General Hospital for Pittsburgh between January 1985 and July 1989. Thirteen patients were identified with isolated sphenoid sinus disease who were successfully managed with sublabial transseptal sphenoidotomy. This approach allows maximal visualization and safety with minimal morbidity.

Hemilaryngectomy for salvage of radiation therapy failures.

Radiation therapy has been the treatment most frequently used for early vocal cord cancer with surgery usually in the form of total laryngectomy held in reserve as a salvage option. We report our experience in selected patients who, having failed radiation therapy for their early vocal cord cancers, underwent frontolateral hemilaryngectomy as attempted salvage surgery. Between 1977 and 1986, fourteen patients at the University of Pittsburgh Eye and Ear Hospital underwent hemilaryngectomy for salvage of their stage I vocal cord squamous cell carcinoma after full-course radiation therapy had been unsuccessful. Over this same time period, 77 patients underwent total laryngectomy for salvage of radiation therapy failure. Three patients failed hemilaryngectomy, two of whom were ultimately salvaged with total laryngectomy. Thus a 79% salvage rate was achieved with hemilaryngectomy with an average followup of 90 months. The overall cure rate was 93% (13 of 14) with voice preservation in 86% (12 of 14). Decannulation, postoperative infection, and initiation of oral intake were not influenced by age. Such problems occurred more often in patients undergoing radiation therapy compared to those undergoing hemilaryngectomy without previous radiation therapy. These results indicate that hemilaryngectomy may be used for the salvage of radiation therapy failures of stage I vocal cord carcinoma with good success and without undue morbidity.

Peritonsillar abscess in Kawasaki disease.

Mucocutaneous lymph node syndrome, Kawasaki disease, is a potentially fatal pediatric disease characterized by prolonged high fever, conjunctivitis, stomatitis. myocarditis, aseptic meningitis and coronary artery vasculitis. We present peritonsillar abscess as a previously unreported otolaryngologic symptom and presentation of Kawasaki disease. A previously healthy 7-year-old boy required hospitalization for a peritonsillar abscess. Despite adequate surgical drainage and appropriate intravenous antibiotics, the patients' systemic symptoms persisted. After the week of hospitalization, the child was transferred to the intensive care unit with acute myocarditis, heart failure and severe arthritis. The diagnosis of Kawasaki disease was confirmed with echocardiographic evidence of coronary artery aneurysms and the development of the characteristic hand and foot desquamation. The patient's symptoms resolved with salicylates and intravenous gamma globulin therapy. He was discharged in good condition after 3 weeks of hospitalization. This is the first report of Kawasaki syndrome presenting with peritonsillar abscess. Although we discuss a unique presentation of this disease. Kawasaki syndrome often exhibits other otolaryngologic findings early in its course. A literature review of the clinical characteristics, pathogenesis and therapy of this disease is presented.

Extramedullary plasmacytoma of the parotid.

Primary extramedullary plasmacytoma (PEMP) is a tumor of atypical neoplastic cells that arise outside the bone marrow in patients without clinical evidence of existing multiple myeloma. These rare tumors, which can occur in virtually any part of the body, have shown a clear predilection for the head and neck. Yet despite the fact that nearly 80% of these tumors can be found in the upper respiratory tract or oral cavity, their involvement in the parotid is singularly rare. The clinical behavior of this tumor is not yet well-defined, and local recurrence, distant metastasis, and transformation to multiple myeloma have all been reported. Since the first case of parotid PEMP was reported in 1965, 8 additional cases have been noted in the literature. This is the 9th case of PEMP of the parotid to be described.

The role of hemilaryngectomy in the management of T1 vocal cord cancer.

A retrospective study was undertaken to assess the outcome of 54 patients who have elected to undergo vertical hemilaryngectomy for T1, NO squamous cell carcinoma of the glottic larynx. Fifty-one (94%) of 54 patients were cured with surgery alone. The voice was preserved in 52 (96%) of 54 patients. In the subgroup of patients who had received no prior radiation therapy, voice preservation was achieved in 98% of patients and ultimate control of disease with cure was achieved in 95%. These data substantiate the contention that vertical hemilaryngectomy offers better cure rates than external beam radiation therapy alone. Our data support the efficacy of hemilaryngectomy in T1, NO glottic carcinoma. These data question the traditional belief that surgery effects its success at the expense of voice preservation, whereas external beam radiation therapy does not.